Information Collection

Initial Notice

IC 200112 under ICR 201204-3170-010 · OMB 3170-0010.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3170-0010 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Forms from GLBA.doc	Other-Model Forms contained in Regul

IC Title:

Initial Notice

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Mandatory

CFR Citation: 12 CFR 1016

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Model Forms contained in Regulation			Forms from GLBA.doc		No		Printable Only

Line of Business: Economic Development

Subfunction: Business and Industry Development

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,055

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	1,055	1,055
Annual IC Time Burden (Hours)	15,298	15,298
Annual IC Cost Burden (Dollars)	341,088	341,088

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.